Ulnar neuropathy at the elbow (UNE) is the second most common upper extremity compression neuropathy. There are four different sites of potential compression in the region of the elbow, from proximal to distal: the medial intermuscular septum, the retroepicondylar groove, the humeroulnar arcade (HUA: the aponeurotic band which joins the two heads of the flexor carpi ulnaris muscle), and at the point of exit of the nerve from the flexor carpi ulnaris. Lesions in the ulnar groove account for most cases; HUA compression is also common. The exit compression syndrome is infrequent, but can be recognized regularly if one is sensitive to its existence. Compression by the medial intermuscular septum (arcade of Struthers) proximal to the elbow is rare.
Clinicians have recognized UNE at least since the nineteenth century. In 1878, Panas 10 described the delayed posttraumatic syndrome subsequently referred to as "tardy ulnar palsy." The original description of HUA compression is generally attributed to Osborne's report in 1957. 9 However, I believe the first recorded description of this syndrome was made in 1922 by the neurologist E. Farquhar Buzzard and his surgical colleague, Percy Sargent. 2 They described a patient with UNE in whom surgical exploration revealed that "the nerve passed beneath a dense fibrous archway which constricted it." 2 In their classic 1958 paper, Feindel and Stratford 7 affirmed these previous observations, described three cases, and proposed the term "cubital tunnel syndrome" to refer to ulnar compression by the HUA.
Most of us have experienced occasional ulnardistribution numbness and paresthesias, particularly at night, which disappear with elbow extension and are short-lived. In most patients with UNE, the initial symptoms consist of such intermittent numbness and tingling. Pain is seldom a prominent feature, and, despite the initial sensory disturbance, loss of